ABCL-322 Retrospective Analysis of Real-World Outcomes in Older Adult Patients With Diffuse Large B-Cell Lymphoma

Abstract

Treatment of older adult patients with diffuse large B-cell lymphoma (DLBCL) seeks to achieve disease remission while minimizing treatment-related toxicities. The use of anthracycline in older adults is associated with increased risk of cardiotoxicity and myelosuppression. Non-anthracycline-based regimens have commonly been used in patients ineligible or at risk of severe toxicities to anthracyclines. To analyze the treatment outcomes of patients with DLBCL aged ≥60 years and compare R-CHOP and R-CEOP regimens. Retrospective study, median follow-up: 22.71 months (IQR 8.55-39.24 months). Single institution, tertiary care cancer center. Those aged ≥60 years and newly diagnosed with DLBCL between January 2014 and December 2018 were included. Of a total of 218 patients, 71 patients received the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) and 137 received R-CE(etoposide)OP chemotherapy. The decision to substitute etoposide for doxorubicin was based on physician's discretion depending on the patient's performance status, cardiac comorbidities, frailty, and available resources for supportive care. Two-year progression-free survival (PFS), 2-year overall survival (OS), Grade III/IV toxicities. The 2-year PFS rate in the R-CHOP group was higher than that in the R-CEOP group (79.1% vs. 49.6%, P-value<0.001); this superiority of R-CHOP was seen in both early and advanced disease. The 2-year OS rate in the overall cohort was significantly higher in the R-CHOP group (86.2% vs. 70.6%, P-value=0.016), and the age group of 60-65 years showed significantly better outcomes with the anthracycline-based regimen. The incidence of febrile neutropenia and grade III/IV hematological toxicities was significantly higher in the R-CHOP group in the age group of 60-65 years. Multivariate analysis showed that ECOG-PS, NCCN-IPI, and chemotherapy regimen were significant factors for 2-year PFS, and NCCN-IPI and chemotherapy regimen were significant factors for 2-year OS. An anthracycline-based regimen should be used in fit older adult patients without absolute cardiac contraindications with careful monitoring for toxicities and access to supportive care. Geriatric assessment tools should be used for better objective assessment of fitness to deliver optimal therapy and lessen the risks of toxicities.